Saint Raphael's Parish, Poultney, Vermont

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Parish Census

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Forms are due by September 11, 2022
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- Family Information
  
  Last Name Please enter valid data.
  
  Salutation (M/M, Mr., Mrs., Ms., etc.): Please enter valid data.
  
  Street Address Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Mailing address (if different) Please enter valid data.
  
  Family Email REQUIRED Please fill out this field. Please enter an email address.
  
  Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Famliy Member REQUIRED Please fill out this field.
  
  Member 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Salutation(Mr., Mrs., Ms., Dr., etc.) Please enter valid data.
  
  Gender Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Ok to text? yes no
  
  Date of Birth Please enter valid data.
  
  Member 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Salutation(Mr., Mrs., Ms., Dr., etc.) Please enter valid data.
  
  Gender Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Ok to text? yes no
  
  Date of Birth Please enter valid data.
- Children and Other Adults at Home REQUIRED Please fill out this field.
  
  Child or Adult at home 1
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Child or Adult at home 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Child or Adult at home 3
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Child or Adult at home 4
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Gender Please enter valid data.
  
  Date of Birth Please enter valid data.
- Which Parish are you assoicated with? REQUIRED Please fill out this field.
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